Intra- and interexaminer reliability of four manual shoulder maneuvers used to identify subacromial pain.

Shoulder pain is a diagnostic challenge and the physical clinical examination of the shoulder is crucial. It is important that the diagnostic tests used are valid as well as reliable. The objective of the study was to assess intra- and interexaminer reliability for four manual shoulder maneuvers; the Neer impingement sign, the Hawkins-Kennedy impingement test, the Patte maneuver, the Jobe supraspinatus test. These maneuvers are frequently used in clinical practice to examine patients with shoulder complaints in which subacromial pain is highly suspected. Thirty-three participants with shoulder pain were included consecutively. Within a week from inclusion, the four maneuvers were performed by a physiotherapist. The procedure was standardized in order to increase reproducibility. After a week, the maneuvers were performed again by the same physical therapist (test-retest) and by another physical therapist (test for interexaminer reliability). All four maneuvers have an almost perfect agreement (Kappa coefficients 0.91-1.00), if performed with suggested standardizations. Neer impingement sign, Hawkins-Kennedy impingement test, Patte maneuver as well as Jobe supraspinatus test, are highly reproducible and therefore reliable to use in clinical practice to identify patients with subacromial pain with an impingement phenomenon, but the maneuvers are limited as structural discriminators.